Tratamiento farmacológico de la hepatitis B
2008
Objective: To define the role of those drugs available for hepatitis B
treatment and analyse current treatment guides prepared by the leading
scientific societies in the field.
Methods: Bibliographic searches were carried out in the databases
PubMed and EMBASE, using the search word «hepatitis B», limited by
«drug therapy» plus «clinical trial», «meta-analysis» or «guidelines»,
within the period 1991-2007.
Results: Six drugs are currently available: interferon alpha (conventional
or pegylated), lamivudine, adefovir, entecavir and telbivudine.
In normal practice, pegylated interferon has almost completely displaced
the conventional variety. HBeAg+ patients with high ALT levels,
low HBV DNA counts and genotypes A and B show the best response
to interferon.
Lamivudine achieves faster and more potent viral suppression than
adefovir; its principal drawback is the resistance that some patients
develop. Its role will probably decrease as entecavir and telbivudine
become more widespread, as they are associated with less resistance.
Adefovir is useful in decompensated patients and/or those resistant
to lamivudine.
Because of the response rates it obtains, entecavir could be the drug
of choice for HBeAG+ patients, particularly those with higher viral
loads. For HBeAg– cases, any drug can be used as a first-choice drug.
The main difference between the treatment guides lies in the way
they define the illness and the serum markers that indicate active replication:
viral loads and HBeAG positivity.
Conclusions: All of the drugs are capable of accomplishing shortterm
biochemical, viral and histological objectives. There is no unanimous
opinion on which patients should be treated with which drugs,
during what length of time, and what objectives are to be reached.
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